急性缺血性脑卒中患者血小板活化水平与全身炎症反应综合征的相关性

目的 动态观察缺血性脑卒中患者外周血血小板活化水平,分析血小板活化与伴发全身炎症反应综合征(SIRS)的关系. 方法 动态监测缺血性脑卒中患者外周血血小板平均内含物浓度(MPC)和白细胞计数及发病早期血浆纤维蛋白原(FIB)和血小板聚集率等指标,比较SIRS组与无SIRS组患者的各项参数,对发病早期MPC水平与SIRS评分以及当日白细胞计数、FIB和血小板聚集率等进行相关性分析. 结果 MPC水平在发病第1天略有下降,从第2天至病程第45天一直保持较低水平,均值在229～242 g/L之间波动.SIRS组与无SIRS组比较发病早期FIB差异无统计学意义(t=1.835,P=0.07),其余各指标差异有统计学意义(均为P＜0.01).发病前3 d MPC水平与SIRS评分呈显著负相关(相关系数分别为-0.392、-0.376、-0.341,t值分别为3.484、3.405、3.125,均为P＜0.01),而与当日白细胞计数、FIB及血小板聚集率无相关性(P＞0.05). 结论 缺血性脑卒中患者整个病程期间血小板一直保持较活化的状态,伴发SIRS的患者发病早期血小板活化水平、白细胞计数和血小板聚集率均高于未伴发SIRS的患者.早期的血小板活化水平提示SIRS的严重程度,血小板活化可能是SIRS的独立危险因素.

Study on correlation between platelet activation and systemic inflammatory response syndrome in patients with acute ischemic stroke

Objective To observe the dynamic level of platelet activation and to analyze the correlation between platelet activation and systemic inflammatory response syndrome(SIRS)in patients with acute ischemie stroke. Methods　Mean platelet component concentration(MPC)and white blood count(WBC)were serially determined in patients with acute isehemic stroke,and other parameters including initial plasma fibrinogen(FIB)and adenosine diphosphate(ADP)aggregative rate were also determined.All parameters were compared between the SIRS group and the non-SIRS group.Correlation was analyzed between initial MPC and SIRS score,WBC,FIB and ADP aggregative rate. Results MPC level was declined slightly on the first day,and was followed by a relatively low MPC level from the second day to the forty-fifth day.The average level was fluctuated between 229 g/L and 242 g/L.There was no significant difference in initial FIB(t=1.835,P=0.07)between the SIRS group and the non-SIRS group,but the differences of other parameters had statistical significance(all P＜0.01).In the first three days,MPC level was negatively correlated with SIRS score(r=-0.392,-0.376,-0.341,t=3.484,3.405,3.125 respectively,all P＜0.01),but not correlated with WBC,FIB and ADP aggregative rate(P＞0.05). Conclusions　Platelets maintain an activated state during the entire course of ischemic stroke.The initial level of platelet activation.WBC count and ADP aggregative rate are higher in SIRS patients than in non-SIRS patients.The initial level of platelet activation suggests the severity of SIRS,and may be one of the independent risk factors for SIRS.